| NPI | 1194987677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-02583) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 271425) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2021-08-18 |