| NPI | 1487090981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 17249) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 277418) |
| Enumeration Date | 2013-05-12 |
| Last Update Date | 2025-03-27 |