| NPI | 1609304872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 305359-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101023156) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2026-03-18 |