| NPI | 1669866158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 291470) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 291470) |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2021-01-08 |