| NPI | 1477993533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A161545) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 285160) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2023-01-13 |