| NPI | 1619007200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 098813) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA GFE22042) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2007-07-08 |