| NPI | 1720059975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 127749) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: NY 127749) |
| 207RE0101X Internal Medicine Endocrinology, Diabetes & Metabolism (Licence: NY 127749) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2007-07-08 |