| NPI | 1003304189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A174435) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 311808) |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2026-06-04 |