| NPI | 1699263590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 311942-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036159729) |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2024-06-10 |