| NPI | 1609309749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: PA MD475496) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 322330) |
| 207R00000X Internal Medicine (Licence: PA MD475496) | |
| 207RH0003X Internal Medicine, Hematology & Oncology (Licence: NY 322330) | |
| 235Z00000X Speech-Language Pathologist, (Licence: NY 322330) | |
| 363A00000X Physician Assistant (Licence: NY 322330) | |
| 363L00000X Nurse Practitioner (Licence: NY 322330) | |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2024-11-26 |