| NPI | 1508247735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 297753) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 263737) |
| 207R00000X Internal Medicine (Licence: MA 273129) | |
| 363AM0700X Physician Assistant Medical (Licence: NY 297753) | |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2023-07-17 |