| NPI | 1881732758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 108744-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 180744-1) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2023-03-07 |