| NPI | 1952864084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 192729) |
| Additional Taxonomies | 207RI0001X Internal Medicine, Clinical & Laboratory Immunology (Licence: TX S5255) |
| 207R00000X Internal Medicine (Licence: TX S5255) | |
| Enumeration Date | 2019-04-06 |
| Last Update Date | 2026-05-26 |