| NPI | 1154429850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 166612) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2016-00926) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-10-06 |