| NPI | 1497916431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NY 285631) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-8428) |
| 207R00000X Internal Medicine (Licence: NY 285631) | |
| 208D00000X General Practice (Licence: IA 40121) | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2022-07-21 |