| NPI | 1831268390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2002015272) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 223108-1) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2007-07-08 |