| NPI | 1003270562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 83030) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 310904) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2021-07-08 |