| NPI | 1922442359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 290850) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: NY 290850) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 290850) | |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2018-03-17 |