| NPI | 1407239247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 296505) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 277995) |
| 207Q00000X Family Medicine (Licence: CA A158993) | |
| 207Q00000X Family Medicine (Licence: FL ME137766) | |
| 207Q00000X Family Medicine (Licence: PA MD465762) | |
| 207Q00000X Family Medicine (Licence: MD D86238) | |
| 207Q00000X Family Medicine (Licence: MI 4301116434) | |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2024-03-18 |