| NPI | 1063505295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 291952) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: NY 291952) |
| 208000000X Pediatrics (Licence: NY 291952) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2018-07-12 |