| NPI | 1770802654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 275684) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 75130) |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2025-11-10 |