| NPI | 1326567629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 283642) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 325164) |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2023-10-04 |