| NPI | 1225130768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO2498) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 266071-1) |
| 208D00000X General Practice (Licence: FL OS11248) | |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2019-02-18 |