| NPI | 1710415021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS16361) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 320438) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2024-01-30 |