| NPI | 1366612863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 281223) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A100867) |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2023-11-27 |