| NPI | 1366688152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 250716) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NY 250716) |
| 261QA0600X Clinic/Center Adult Day Care (Licence: NY 250716) | |
| 261QP2300X Clinic/Center Primary Care (Licence: NY 250716) | |
| Enumeration Date | 2008-12-28 |
| Last Update Date | 2022-07-21 |