| NPI | 1932151982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 173806-1) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 173806) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2011-10-04 |