| NPI | 1639675424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WV 30247) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY AL4978841) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2021-07-30 |