| NPI | 1700049814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 261174) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA 18430) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2016-06-10 |