| NPI | 1316139553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 219992) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 60-219992) |
| 207Q00000X Family Medicine (Licence: NY 219992) | |
| Enumeration Date | 2007-08-12 |
| Last Update Date | 2014-08-19 |