| NPI | 1205369048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 334043) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME150602) |
| Enumeration Date | 2017-04-08 |
| Last Update Date | 2025-08-13 |