| NPI | 1174520456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 146071) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME135082) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2023-08-24 |