| NPI | 1306134978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 268859) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 276971) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2024-01-12 |