| NPI | 1447643440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 276770) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 289249) |
| Enumeration Date | 2015-03-15 |
| Last Update Date | 2018-10-05 |