| NPI | 1548753080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 312533) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.071934) |
| Enumeration Date | 2018-06-10 |
| Last Update Date | 2021-09-26 |