| NPI | 1376539213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 040411) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 2150681) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2019-01-14 |