| NPI | 1629207907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 278307) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 003577) |
| 207R00000X Internal Medicine (Licence: CT 053823) | |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2016-12-02 |