| NPI | 1184665929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16591) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 213557) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2022-03-23 |