| NPI | 1770689986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 199989) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 199989) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2019-01-16 |