| NPI | 1154568707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 53587) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: NY 257673) |
| Enumeration Date | 2009-01-18 |
| Last Update Date | 2022-01-02 |