| NPI | 1962857151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 308304) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 279086) |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2022-12-13 |