| NPI | 1730643586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 324601) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY P14330) |
| Enumeration Date | 2019-01-25 |
| Last Update Date | 2023-07-27 |