| NPI | 1265851364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 202302673) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 67533-20) |
| 207R00000X Internal Medicine (Licence: MN 61957) | |
| 207R00000X Internal Medicine (Licence: NY 314550) | |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2023-09-25 |