| NPI | 1477088656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME148894) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 307885) |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2024-12-31 |