| NPI | 1154620987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 38904) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 275824) |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2021-11-29 |