| NPI | 1487689808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME97554) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 222724) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2021-08-02 |