| NPI | 1821250192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 242468) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 242468-1) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2014-01-23 |