| NPI | 1831326461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 50915) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 274346-126) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2017-03-23 |