| NPI | 1093200115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 312315) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.072738) |
| Enumeration Date | 2018-06-30 |
| Last Update Date | 2021-10-04 |