| NPI | 1518245638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 298582) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 259187) |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2025-11-07 |