| NPI | 1730704560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL DO3459) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 251300000X) |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2025-06-19 |