| NPI | 1558410191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 272208) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 15352) |
| 207Q00000X Family Medicine (Licence: NH LT 3042) | |
| 207Q00000X Family Medicine (Licence: PA OS016477) | |
| 207Q00000X Family Medicine (Licence: ME 2097) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2020-05-22 |