| NPI | 1568811008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 296995) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 296995) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: NY 296995) | |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: NY 296995) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY 296995) | |
| 208M00000X Hospitalist (Licence: NY 296995) | |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2020-12-14 |