| NPI | 1821550294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 318554) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 82153) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2025-09-15 |