| NPI | 1164508388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 236205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101237298) |
| 207Q00000X Family Medicine (Licence: CA 236205-1) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2008-02-27 |