| NPI | 1396998977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 324278) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 250840-1) |
| 208600000X Surgery (Licence: NY 250840) | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2021-06-01 |