| NPI | 1851352926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 192757-1) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NY 192757) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2019-03-01 |