| NPI | 1629036579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 199362) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 78217) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2009-08-28 |