| NPI | 1144597527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 285440) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01071217A) |
| Enumeration Date | 2011-11-29 |
| Last Update Date | 2019-06-05 |