| NPI | 1164666277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 41288) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 260262) |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2014-02-09 |