| NPI | 1093379489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 100664) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 340775) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2026-07-02 |