| NPI | 1639486327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: NY 258201) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NY 258201) |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2014-03-13 |