| NPI | 1114487170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 318798) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 318798) |
| 208000000X Pediatrics (Licence: NY 318798) | |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2024-06-06 |