| NPI | 1013936798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 170712) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: NY 170712) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2023-06-02 |