| NPI | 1558000406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 337532) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2022019686) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2025-08-05 |