| NPI | 1922211853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 254796) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH LT2987) |
| 207R00000X Internal Medicine (Licence: PA MD440552) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2015-11-02 |