| NPI | 1568460186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 044392) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 235586) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2007-07-08 |