| NPI | 1558424218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 36482) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 212751) |
| Enumeration Date | 2006-12-17 |
| Last Update Date | 2019-01-22 |