| NPI | 1710960539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 159811) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 027100) |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2023-01-10 |