| NPI | 1578988374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 273506) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 101256034) |
| Enumeration Date | 2014-03-03 |
| Last Update Date | 2017-03-07 |