| NPI | 1811151160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 271453) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 003818) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2023-10-13 |