| NPI | 1609934025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 229831-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 229831) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2010-03-24 |