| NPI | 1194991737 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-127800)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 255474)  | 
| Enumeration Date | 2008-05-04 | 
| Last Update Date | 2024-05-16 |