| NPI | 1811972698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 148605) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 027982) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2013-12-26 |