| NPI | 1144904624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 345961) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 3014542) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2026-06-29 |