| NPI | 1023695913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 0420017620) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 34734501) |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2026-09-22 |