| NPI | 1578565032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2006-01936) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 215918) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2015-01-23 |