| NPI | 1922461128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 303271) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2019-00286) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2020-12-09 |