| NPI | 1770882441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 274397) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 390200000X) |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2014-08-28 |