| NPI | 1598866782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 86671) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 232674) |
| 207Q00000X Family Medicine (Licence: NY 232674) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2021-05-26 |