| NPI | 1386205748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 333105) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2022018893) |
| 207R00000X Internal Medicine (Licence: NC 2024-03230) | |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2024-12-04 |