| NPI | 1730166232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 134947) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 134947) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2011-05-05 |