| NPI | 1992148647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 285632) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 29952) |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2022-07-21 |