| NPI | 1811497381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 272490-1) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 292490) |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2018-02-20 |