| NPI | 1669455655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 252089) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 221060) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2022-12-06 |