| NPI | 1568753978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 272973) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 63069) |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2014-06-04 |