| NPI | 1679500086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 165978) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 026499) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2020-09-17 |