| NPI | 1831719038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 323872) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 76990) |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2024-04-01 |