| NPI | 1518304823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 284536) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2019-02380) |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2021-03-22 |