| NPI | 1851710370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 307249) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 056458) |
| Enumeration Date | 2014-04-11 |
| Last Update Date | 2020-09-24 |