| NPI | 1417936501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 189767) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 189767) |
| 207Q00000X Family Medicine (Licence: NY 189767) | |
| 208M00000X Hospitalist (Licence: NY 189767) | |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2017-01-04 |