| NPI | 1831611367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 324282) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.152624) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2023-07-14 |