| NPI | 1780919266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 142517) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 142517) |
| 208D00000X General Practice (Licence: NY 142517) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NY 142517) | |
| Enumeration Date | 2009-10-16 |
| Last Update Date | 2015-11-05 |