| NPI | 1609197458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY A258376-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 258376) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2021-10-07 |