| NPI | 1578592218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 228014) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 241144) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2024-06-26 |