| NPI | 1922354240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 281590) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A128610) |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2015-10-05 |