| NPI | 1912587510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 331745) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME169539) |
| 207R00000X Internal Medicine (Licence: NJ 25MA12314900) | |
| 207R00000X Internal Medicine (Licence: GA 101585) | |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2024-09-03 |