| NPI | 1982966024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 280033) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 251756) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2015-07-23 |