| NPI | 1811927015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 005951-1) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 5951) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2023-07-06 |