| NPI | 1982642096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 1469) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 174478) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2012-01-26 |