| NPI | 1437230661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 207150) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 207150) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2022-10-14 |