| NPI | 1174964415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 296567) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 055086) |
| 208M00000X Hospitalist (Licence: NY 296567) | |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2026-05-05 |