| NPI | 1508326661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1014283) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 320153) |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2023-05-11 |