| NPI | 1043295413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 256970) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 36174) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2021-02-20 |