| NPI | 1710514849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A196153) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 323239) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2024-10-25 |