| NPI | 1265751903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 075141) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 271021) |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2022-01-10 |