| NPI | 1982735916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101046655) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 167135) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2013-10-09 |