| NPI | 1891785440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 306978) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 157707) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2021-03-23 |