| NPI | 1619961224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 130193) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NY 130193) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2013-02-12 |