| NPI | 1134413172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086H0002X Surgery, Hospice and Palliative Medicine (Licence: NY 292054) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 292054-1) |
| 207Q00000X Family Medicine (Licence: NE 27161) | |
| 208D00000X General Practice (Licence: NE 27161) | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2021-05-14 |