| NPI | 1093891079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 145218) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: NY 145218) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2008-07-29 |