| NPI | 1790712925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 47607) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 236343) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2015-09-17 |