| NPI | 1972916419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 0960827815) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 287825) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2022-06-27 |