| NPI | 1144635350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 302362) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101258780) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2022-12-21 |