| NPI | 1750448031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 136080) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 136080) |
| 208600000X Surgery (Licence: NY 136080) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2023-03-07 |