| NPI | 1366495129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD28172) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 002039) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2009-06-29 |