| NPI | 1871055418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101284640) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME154818) |
| 207R00000X Internal Medicine (Licence: NY 317848) | |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2025-02-06 |