| NPI | 1487074639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-9902) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 274782) |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2016-08-02 |