| NPI | 1598569212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 173213) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 154425) |
| Enumeration Date | 2025-04-02 |
| Last Update Date | 2025-04-02 |