| NPI | 1912166679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D69581) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 248289) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2013-02-04 |