| NPI | 1043453061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200400834) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 83188) |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2009-04-07 |