| NPI | 1659379691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 236906) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME96813) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2024-01-04 |