| NPI | 1811060833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 133408) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: NY 133408) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2007-07-08 |