| NPI | 1518166461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301091423) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 244888) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2023-03-07 |