| NPI | 1952566655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2016-01510) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 246230) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2020-09-28 |