| NPI | 1336163682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 13614) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 180611) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2019-10-02 |