| NPI | 1043707953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 312362) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351033894) |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2021-08-03 |