| NPI | 1619473485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 288282) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 314292) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2022-10-02 |