| NPI | 1104288281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 296968) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS14866) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2020-04-13 |