| NPI | 1275945990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 87793) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 290576) |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2022-09-26 |