| NPI | 1477712644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 260065) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2010-01512) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2016-12-16 |