| NPI | 1205028560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 46754) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 243843) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2024-04-03 |