| NPI | 1972598639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A77102) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 235957) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2021-12-15 |