| NPI | 1902081797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 265426) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D70773) |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2019-04-25 |