| NPI | 1871818195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036158455) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 281804) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2026-06-02 |