| NPI | 1649425885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 253786) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 47708) |
| Enumeration Date | 2008-12-01 |
| Last Update Date | 2011-10-07 |