| NPI | 1710941521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 159107) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 159107) |
| 208D00000X General Practice (Licence: NY 159107) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2022-08-05 |