| NPI | 1386673622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301508919) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 162638) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2023-09-15 |