| NPI | 1790741395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 127629-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME81472) |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2025-06-19 |