| NPI | 1255334876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 201718) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: NY 201718) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2025-02-05 |