| NPI | 1285791178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 217859) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 217859) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2021-03-17 |