| NPI | 1659650992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL uo2883) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 279030) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2021-03-23 |