| NPI | 1376529230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 22425) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 192319) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2022-11-14 |