| NPI | 1598764953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 158896) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME50383) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2012-08-10 |