| NPI | 1649297391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 162747) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 162747) |
| 207P00000X Emergency Medicine (Licence: NY 162747) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2011-03-08 |