| NPI | 1083364582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 339632-01) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 339632-01) |
| Enumeration Date | 2022-03-27 |
| Last Update Date | 2026-09-11 |