| NPI | 1881211621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 323621) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 074030) |
| Enumeration Date | 2020-06-27 |
| Last Update Date | 2025-06-12 |