| NPI | 1073546131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 215638) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 215638) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2025-11-20 |