| NPI | 1740662592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 304027) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0085683) |
| Enumeration Date | 2015-06-28 |
| Last Update Date | 2020-11-20 |