| NPI | 1912903253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD429239) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 226415) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NY 226415) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2009-06-11 |