| NPI | 1164957767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY 307803) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NJ 25MA11234100) |
| 2083B0002X Preventive Medicine, Obesity Medicine (Licence: NY 307803) | |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2024-06-18 |