| NPI | 1063751444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A192723) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 285488-1) |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2026-05-04 |