| NPI | 1922530013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 307779) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 61590) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2026-05-06 |