| NPI | 1649406307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 170616) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 102110) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2025-08-22 |