| NPI | 1649626508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 301369) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 301369) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2021-04-22 |