| NPI | 1902030869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 249492) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 249492) |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2024-06-14 |