| NPI | 1336463371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 274321) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 54687) |
| Enumeration Date | 2010-03-19 |
| Last Update Date | 2021-12-01 |