| NPI | 1639726052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 319301) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 319301) |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2023-07-22 |