| NPI | 1346943297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 90359LL) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2023010742) |
| 207Q00000X Family Medicine (Licence: NY P121157) | |
| 207R00000X Internal Medicine (Licence: NY P121157) | |
| 207R00000X Internal Medicine (Licence: MO 2023010742) | |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2023-06-29 |