| NPI | 1437311289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 249773) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 50627) |
| 207Q00000X Family Medicine (Licence: NY 249485) | |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2022-12-21 |