| NPI | 1457550071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 268111) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 268111-1) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2016-04-08 |