| NPI | 1992704233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 255584-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 042156) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2016-01-26 |