| NPI | 1205377496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 322214) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 284119) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2023-06-16 |