| NPI | 1083798920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 147423) |
| Additional Taxonomies | 207QA0000X Family Medicine Adolescent Medicine (Licence: NY 147423) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2013-08-20 |