| NPI | 1104900034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 0083026) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 218930) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2019-09-06 |