| NPI | 1780678862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME110720) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 139889) |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2011-12-19 |