| NPI | 1215092663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME65265) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 153645) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2019-10-07 |