| NPI | 1528068269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 41203) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 215400) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2026-08-05 |