| NPI | 1841363579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 185171) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 185171) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2015-12-08 |