| NPI | 1437311487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 250936) |
| Additional Taxonomies | 193400000X Single Specialty (Licence: NY 250936) |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2023-09-14 |