| NPI | 1922469105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 299186) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 299186) |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2024-04-16 |