| NPI | 1194246397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 315178) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 272571) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2023-02-20 |