| NPI | 1639532302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A178103) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 64120) |
| 207R00000X Internal Medicine (Licence: NY 303168) | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2024-04-09 |