| NPI | 1053579888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 268708) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101247877) |
| 207R00000X Internal Medicine (Licence: OH 35.095370) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2022-12-23 |