| NPI | 1124339080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 281898) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NY 281898) |
| 208M00000X Hospitalist (Licence: NY 281898) | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2021-04-25 |