| NPI | 1851582092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 237457) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 201001347) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2013-02-20 |