| NPI | 1548214612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 38941) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 153414) |
| Enumeration Date | 2006-05-21 |
| Last Update Date | 2018-12-21 |