| NPI | 1780630830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 224502) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 224502-1) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2020-12-01 |