| NPI | 1508360496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 22153) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 307974) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2022-07-26 |