| NPI | 1043209885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 264891-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD20050192) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2012-07-09 |