| NPI | 1114219201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 280538) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 280538) |
| Enumeration Date | 2011-05-06 |
| Last Update Date | 2021-05-25 |