| NPI | 1639832124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-02453) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY P112080) |
| Enumeration Date | 2021-10-21 |
| Last Update Date | 2025-09-24 |