| NPI | 1306332739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2023-02864) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 311669) |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2023-09-27 |