| NPI | 1912908005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 134470) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY 134470) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2010-08-05 |