| NPI | 1700106143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 107597) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 277869) |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2023-10-31 |