| NPI | 1467785139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 272299) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 52346) |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2021-03-12 |