| NPI | 1720071095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 320347) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: VT 042-0009268) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2024-01-08 |