| NPI | 1902044464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 265040) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 003510) |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2015-12-13 |