| NPI | 1053637561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 275445) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 269392) |
| Enumeration Date | 2010-04-09 |
| Last Update Date | 2018-09-19 |