| NPI | 1467431106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 222120) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 222120) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NY 222120) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2010-02-11 |