| NPI | 1790180768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NY 305124) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 305124) |
| 208000000X Pediatrics (Licence: NY 305124) | |
| Enumeration Date | 2014-11-03 |
| Last Update Date | 2025-06-11 |