| NPI | 1881977619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 291040) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125060165) |
| 207R00000X Internal Medicine (Licence: CA 131265) | |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2018-06-13 |