| NPI | 1932134830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 056910) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD417056) |
| 207R00000X Internal Medicine (Licence: NY 228488) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2011-08-19 |