| NPI | 1124609615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 325297) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 1018966) |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2025-02-01 |