| NPI | 1790982478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 244406) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 244406) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2014-02-13 |