| NPI | 1720013782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 135662) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G89230) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2013-08-01 |