| NPI | 1770528267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301076162) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 296648) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2018-12-01 |