| NPI | 1306028626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 164627) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 164627) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2016-03-10 |