| NPI | 1265708911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D81595) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 7721) |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2021-04-19 |