| NPI | 1588673495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12128) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 230204) |
| 207Q00000X Family Medicine (Licence: NY 230204) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2020-12-23 |