| NPI | 1639145659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 231226) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 231226) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2008-04-22 |