| NPI | 1063590891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 240497) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A87766) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2012-07-19 |