| NPI | 1740568153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 266344) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 276713) |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2025-01-16 |