| NPI | 1104804525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 259479) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME81222) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2019-05-07 |