| NPI | 1003996042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C183605) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 236059) |
| 207R00000X Internal Medicine (Licence: CT 052165) | |
| 261QM1300X Clinic/Center, Multi-Specialty (Licence: NY 236059) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2023-11-27 |