| NPI | 1396059150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD191405) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 272646) |
| 207Q00000X Family Medicine (Licence: AL L.3596R) | |
| 207Q00000X Family Medicine (Licence: CT 053530) | |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2019-06-13 |