| NPI | 1841510492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 22500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 274998) |
| Enumeration Date | 2010-06-06 |
| Last Update Date | 2025-07-23 |