| NPI | 1851754295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 313522) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 4792) |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2022-12-14 |