| NPI | 1114162831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 277561) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 240167) |
| Enumeration Date | 2008-12-09 |
| Last Update Date | 2019-08-07 |