| NPI | 1104084862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 256174) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: PA os 2964-L) |
| 207Q00000X Family Medicine (Licence: PA os 2964-L) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2024-10-15 |