| NPI | 1871589556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 122028) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 122028) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2010-06-25 |