| NPI | 1033374715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A11262) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 247534) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2021-12-15 |