| NPI | 1275511560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 136530) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NY 136530) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 136530) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2023-03-07 |