| NPI | 1700873460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 200801787) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 206547) |
| Enumeration Date | 2005-09-28 |
| Last Update Date | 2023-01-27 |