| NPI | 1790063477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301114943) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 274406) |
| Enumeration Date | 2011-07-28 |
| Last Update Date | 2018-06-19 |