| NPI | 1871565119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 178419-1) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 178419) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2016-06-24 |