| NPI | 1972674414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 163432) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 163462) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2022-07-07 |