| NPI | 1093745945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 178332) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME100693) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2014-11-07 |