| NPI | 1962044396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 337790) |
| Additional Taxonomies | 207QB0002X Family Medicine, Bariatric Medicine (Licence: NY 337790) |
| 202K00000X Phlebology (Licence: NY 337790) | |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2026-05-02 |