| NPI | 1205413234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 331519) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL MD.45354) |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2025-06-04 |