| NPI | 1982670360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101247529) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 225554) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2013-01-09 |