| NPI | 1992703045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101244821) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 148475) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2010-05-11 |