| NPI | 1003950890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 7898) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 205950) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2021-06-29 |