| NPI | 1851387971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 139718) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 021366) |
| 207R00000X Internal Medicine (Licence: AL 20577) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2020-05-27 |