| NPI | 1932857901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A209346) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 337759-01) |
| Enumeration Date | 2022-03-17 |
| Last Update Date | 2026-08-05 |