| NPI | 1952456808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 238268-1) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 238268) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NY 238268) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2021-12-14 |