| NPI | 1912077918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 210251) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 037923) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2026-03-04 |