| NPI | 1114182458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 059670) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 048) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2015-04-29 |