| NPI | 1770074510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 312210) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 312210) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2021-10-12 |