| NPI | 1780884320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 286989) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 48934) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2019-10-23 |