| NPI | 1376709493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 320993) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101248233) |
| 207Q00000X Family Medicine (Licence: TX S6111) | |
| 207Q00000X Family Medicine (Licence: NY 25MA11713300) | |
| 207Q00000X Family Medicine (Licence: IN 01081343A) | |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2023-06-09 |