| NPI | 1891961413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 039179) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 158849-1) |
| Enumeration Date | 2008-05-03 |
| Last Update Date | 2021-04-15 |