| NPI | 1679665103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 117960) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME65383) |
| 207R00000X Internal Medicine (Licence: NY 193762) | |
| 207R00000X Internal Medicine (Licence: NJ 25MA05864700) | |
| 207R00000X Internal Medicine (Licence: KY 31490) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2013-04-04 |