| NPI | 1912999608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 175085) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 119752) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2022-07-21 |