| NPI | 1417936204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 137890-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 027612) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2013-10-16 |