NPI | 1972664829 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 164125) |
Additional Taxonomies | 208D00000X General Practice (Licence: NY 164125) |
2083X0100X Preventive Medicine, Occupational Medicine (Licence: NY 164125) | |
207R00000X Internal Medicine (Licence: PA MD041171E) | |
Enumeration Date | 2006-12-13 |
Last Update Date | 2011-02-02 |