| NPI | 1659379014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 204231) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 46212) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2023-06-08 |