| NPI | 1639818321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125080314) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 338042) |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2025-07-09 |