| NPI | 1477783827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A116289) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 333580) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2026-01-23 |