| NPI | 1497831721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 177324) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 177324) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 177324) | |
| Enumeration Date | 2006-10-30 |
| Last Update Date | 2009-09-17 |