| NPI | 1104245646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0092166) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 287828) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2022-08-17 |