| NPI | 1700972155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 059795) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 232545) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-02-26 |