| NPI | 1689614117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 234086) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 219162) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2013-04-11 |