| NPI | 1780820753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 062989) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 250913) |
| Enumeration Date | 2008-12-22 |
| Last Update Date | 2021-10-11 |