| NPI | 1700985231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 162617-1) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY 162617-1) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2008-06-27 |