| NPI | 1083973374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0116024095) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 280169) |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2025-12-05 |