| NPI | 1659521797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 88814) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 257539) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2021-12-15 |