| NPI | 1821245325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NY 252947) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CT 054178) |
| 208D00000X General Practice (Licence: CT 054178) | |
| 208D00000X General Practice (Licence: NY 252947) | |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2016-12-28 |