| NPI | 1790913358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 273138) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 240876) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2014-07-24 |