| NPI | 1639532476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 299476) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NY 299476) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NY 299476) | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2026-03-31 |