| NPI | 1780324533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A197222) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 346768) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2026-08-07 |