| NPI | 1528054210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 045771) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 225097) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2023-05-08 |