| NPI | 1598119083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C198218) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 303196) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2024-09-25 |