| NPI | 1952644270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 287718) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 287718) |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2023-07-07 |