| NPI | 1376993287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 297124) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 274346435) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2019-01-30 |