| NPI | 1215015953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A115526) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 13673) |
| 207QA0000X Family Medicine Adolescent Medicine (Licence: NY 240096) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2019-01-23 |