| NPI | 1104014422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 245840-1) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 245840) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2017-01-12 |