| NPI | 1336375229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 281958-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101250171) |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2024-07-16 |