| NPI | 1932212271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 036479) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 175086-1) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2025-01-12 |