| NPI | 1760700074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D85159) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 269507) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2020-08-04 |