| NPI | 1720021108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 203697-1) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 203697) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2008-07-02 |