| NPI | 1467421305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 208587-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 208587) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2021-03-28 |