| NPI | 1396729984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: NY 194759) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 194759) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2025-04-08 |