| NPI | 1780916213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 2043243423) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 20024323) |
| Enumeration Date | 2010-02-09 |
| Last Update Date | 2013-07-22 |