| NPI | 1568456713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 223668) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-19712) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2023-03-07 |