| NPI | 1295149102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: FL UO8540) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 281959) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2022-10-11 |