| NPI | 1609309871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY F341672) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F341672) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2022-11-01 |