| NPI | 1376549865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NY 111543) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 111543) |
| 207R00000X Internal Medicine (Licence: NY 111543) | |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2008-03-10 |