| NPI | 1255443115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 188421-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 188421-1) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-06-26 |