| NPI | 1871173823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 331663) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: CT 76152) |
| 208D00000X General Practice (Licence: WI 82776-20) | |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2025-09-15 |