| NPI | 1558418988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 25881) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 242327) |
| 207Q00000X Family Medicine (Licence: NY 242327) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NY 242327) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2024-09-24 |