| NPI | 1912081845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 197216) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: NY 197216) |
| 207R00000X Internal Medicine (Licence: NY 197216) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-12-24 |