| NPI | 1396066551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 263455-1) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 119585) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2015-02-11 |