| NPI | 1417010869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA c53520) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 224878) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2026-07-29 |