| NPI | 1255451811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D55869) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A60939) |
| 207Q00000X Family Medicine (Licence: NY 197637) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2022-03-09 |