| NPI | 1700917952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 22101) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME 30738) |
| 207R00000X Internal Medicine (Licence: NY 207016) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2026-08-13 |