| NPI | 1538166095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101278262) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 206689-1) |
| 208000000X Pediatrics (Licence: NY 206689-1) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2023-09-12 |