| NPI | 1477819027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 56415) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 2788741) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2022-03-21 |