| NPI | 1346222841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 155486) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: NY 155486) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2007-07-08 |