| NPI | 1780208793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A187092) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP05043) |
| 207R00000X Internal Medicine (Licence: NY 332184) | |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2025-12-01 |