| NPI | 1336194695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 010166) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 1-203966) |
| 207Q00000X Family Medicine (Licence: CA 20A15269) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2023-08-17 |