| NPI | 1497827760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 195743) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NY 195743) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2017-06-12 |