| NPI | 1740466168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 50006) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 246769) |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2017-04-06 |