| NPI | 1578598561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 228770) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 229774) |
| 207R00000X Internal Medicine (Licence: CA A117312) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2013-05-31 |