| NPI | 1497281240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 306283) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN24776) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2020-10-08 |