| NPI | 1811217714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 053330) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 276716) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2020-10-19 |