| NPI | 1003195215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 312485) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2017039278) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2024-05-03 |