| NPI | 1063743169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 261327) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 64250) |
| 207R00000X Internal Medicine (Licence: NY 2613271) | |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2023-01-28 |