| NPI | 1770597643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 150421) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 150421) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2007-07-08 |