| NPI | 1255413050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 153429) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: NY 153429) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2023-06-15 |