| NPI | 1518247600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 262653) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME142149) |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2025-09-09 |