| NPI | 1972680239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 234537) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 101237135) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2025-11-19 |