| NPI | 1740817113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 85264) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 325002) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2026-06-17 |