| NPI | 1538458864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 34977) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 272513) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2022-07-18 |