| NPI | 1063611481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 320247-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD11918) |
| 207R00000X Internal Medicine (Licence: NC 2015-02505) | |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2023-01-18 |