| NPI | 1962897744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 292485) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 292485) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2020-09-08 |