| NPI | 1588699797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL os10028) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 2119861) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2014-06-23 |