| NPI | 1619175676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A120581) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 258123) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2015-06-09 |