| NPI | 1720057599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 150109) |
| Additional Taxonomies | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: NY 150109) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2021-10-01 |