| NPI | 1699731588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 204934-1) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NY 204934) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2021-12-06 |