| NPI | 1477815843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 284448) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME113127) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2016-11-05 |