| NPI | 1891964904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A111104) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 247260) |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2025-04-02 |