| NPI | 1649219858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY A112387-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 31913) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2020-11-19 |