| NPI | 1467658153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY 265835) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 003117) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207Q00000X Family Medicine (Licence: NY 265835) | |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2013-03-29 |