| NPI | 1396851218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-00727) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 51907) |
| 207Q00000X Family Medicine (Licence: NY 208853) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2019-12-05 |