| NPI | 1154446615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 70487) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 309550) |
| 363A00000X Physician Assistant (Licence: NY 010943) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2022-06-14 |