| NPI | 1629040704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 263892) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD030819E) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2012-04-17 |