| NPI | 1104800333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 114830) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 114830) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2007-07-08 |