| NPI | 1578568150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 164798) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 055562) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2014-11-04 |