| NPI | 1104889740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 184266) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101056695) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2023-08-04 |