| NPI | 1508094814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 266401) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 252505) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2012-12-07 |