| NPI | 1629430483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A185074) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 295895) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2025-03-26 |