| NPI | 1588612774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C152587) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 230583) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2018-08-06 |