| NPI | 1053311035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: MD D0063195) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 220715) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: MD D0063195) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2009-07-06 |