| NPI | 1851581383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 272836) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-6146) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2014-03-27 |