| NPI | 1114017647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 250381) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301064063) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2022-03-28 |