| NPI | 1306266952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 390200000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 287960) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2018-06-06 |