| NPI | 1164771374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 280483) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 280483) |
| Enumeration Date | 2012-09-04 |
| Last Update Date | 2015-06-30 |