| NPI | 1235626391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 308308) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 308308) |
| Enumeration Date | 2018-04-15 |
| Last Update Date | 2023-07-07 |