| NPI | 1508133539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 280433) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: NY 280433) |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2023-09-01 |