| NPI | 1518655778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY P133128) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: 21-689) |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2025-06-21 |