| NPI | 1104005909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 246059) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 246059) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2025-10-11 |