| NPI | 1922439009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 285552) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN19122) |
| Enumeration Date | 2013-11-27 |
| Last Update Date | 2018-08-30 |