| NPI | 1407869993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 158093) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 158093) |
| 208D00000X General Practice (Licence: HI MD-10194) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2016-02-26 |