| NPI | 1780787804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 286774) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A90696) |
| 207R00000X Internal Medicine (Licence: GA 062129) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2017-02-03 |