| NPI | 1871640599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 278742-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NH LT-2533) |
| 207P00000X Emergency Medicine (Licence: NY 278742) | |
| 207Q00000X Family Medicine (Licence: NH 13772) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2024-12-26 |