| NPI | 1376578500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2016-0863) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 199224) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2017-03-28 |