| NPI | 1215221684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 273851) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC MMD.33588 LL) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2021-11-19 |