| NPI | 1225101678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME110345) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 2024531) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2011-10-27 |