| NPI | 1548820806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 323967) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 167320) |
| 207Q00000X Family Medicine (Licence: FL ME161809) | |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2023-07-20 |