| NPI | 1376169730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY P105251) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A205905) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2026-06-30 |