| NPI | 1962765560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: NY 279188) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-251502) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2019-09-27 |