| NPI | 1871087957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A173835) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT216737) |
| 207R00000X Internal Medicine (Licence: NY 312109) | |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2023-08-07 |