| NPI | 1013470418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 72566) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 327094-01) |
| 207R00000X Internal Medicine (Licence: MA 1015290) | |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2024-02-22 |