| NPI | 1285029413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 69554) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 291907) |
| Enumeration Date | 2015-04-04 |
| Last Update Date | 2021-11-17 |