| NPI | 1063776508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 282411) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 282411) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2019-06-19 |