| NPI | 1891706768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 058876) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 152906) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2009-09-01 |