| NPI | 1588282362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 324018) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2025-03781) |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2026-04-12 |