| NPI | 1124688593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 318164) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS21729) |
| 207R00000X Internal Medicine (Licence: CA 20A25218) | |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2026-03-17 |