| NPI | 1891042016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 072624-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 072624-01) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2015-05-19 |