| NPI | 1689716052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 261517) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME109916) |
| 207R00000X Internal Medicine (Licence: PA MD4425509) | |
| 213E00000X Podiatrist (Licence: NY N005654) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2024-01-09 |