| NPI | 1871869073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 055456) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 281253-1) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2016-09-09 |