| NPI | 1417451071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.072598) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 310170) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2024-06-18 |