| NPI | 1982049888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 282114) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 057018) |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2017-09-25 |