| NPI | 1083293559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 33282501) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 169401) |
| Enumeration Date | 2021-04-03 |
| Last Update Date | 2024-09-27 |