| NPI | 1356832943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 309713) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 309713) |
| Enumeration Date | 2018-05-20 |
| Last Update Date | 2023-07-07 |