| NPI | 1932112364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2006024355) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 219869-1) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2022-07-21 |