| NPI | 1154410538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 062611) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 164682) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2024-05-10 |