| NPI | 1447207071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 230165) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 230165-1) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2014-06-04 |