| NPI | 1730138264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H0073248) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 220816) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2013-09-25 |