| NPI | 1982862181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 268208) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 237676) |
| Enumeration Date | 2008-05-26 |
| Last Update Date | 2013-04-16 |