| NPI | 1578889556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 072409) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 271710) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2017-10-18 |