| NPI | 1649791385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD207654) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 305859) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2022-04-26 |