| NPI | 1619138393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 261826) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 051607) |
| 207Q00000X Family Medicine (Licence: AR E 6375) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2015-04-21 |