| NPI | 1235323171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 245865) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 245865) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NY 245865) | |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2007-09-04 |