| NPI | 1508832189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2007-01517) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 042750) |
| 207R00000X Internal Medicine (Licence: NY 180942-1) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2013-04-01 |