| NPI | 1710993373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9501640) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 179825) |
| 208000000X Pediatrics (Licence: NC 9501640) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2026-03-31 |