| NPI | 1265790901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A138715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 281626) |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2021-12-03 |