| NPI | 1659665032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME MD20028) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 266286) |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2014-03-26 |