| NPI | 1730154402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 250442) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 217405) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2010-06-18 |