| NPI | 1508804816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 186558) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 153372) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2023-06-06 |