| NPI | 1093394207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 331922) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 331922) |
| 363A00000X Physician Assistant (Licence: NY 331922) | |
| 363L00000X Nurse Practitioner (Licence: NY 331922) | |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2025-04-08 |