| NPI | 1295939494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 246551) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 35933) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2018-06-22 |