| NPI | 1720574346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 317519) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY P11365) |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2023-12-19 |