| NPI | 1902480023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 334689) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 1019659) |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2026-08-06 |