| NPI | 1134596703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD D0020038) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 1849771) |
| Enumeration Date | 2015-08-30 |
| Last Update Date | 2015-08-30 |