| NPI | 1720405194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 288131) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 56345) |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2017-05-10 |