| NPI | 1336146364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 158348) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 158348) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2023-09-19 |