| NPI | 1689841512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 262448) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C1-0010091) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2014-04-29 |