| NPI | 1881612935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 1865181) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N3498) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2026-05-28 |