| NPI | 1063657591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 250773) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 250773) |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2015-01-16 |