| NPI | 1871188086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 60-P123692-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021007766) |
| Enumeration Date | 2021-03-09 |
| Last Update Date | 2023-08-02 |