| NPI | 1053318576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 211266) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 211266) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NY 211266) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2021-05-10 |