| NPI | 1467452029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 156200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 267506) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2023-03-01 |