| NPI | 1386969673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 227851) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA a76337) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2010-03-30 |