| NPI | 1356418305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 6063) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 128555) |
| 207Q00000X Family Medicine (Licence: PA 21427E) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2007-07-08 |