| NPI | 1609228105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 301698) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 64358) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2022-09-16 |