| NPI | 1306077912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 263438) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 263438) |
| 207Q00000X Family Medicine (Licence: WI 65651-20) | |
| Enumeration Date | 2009-07-30 |
| Last Update Date | 2017-04-03 |