| NPI | 1558555649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101262192) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 243037) |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2018-10-24 |