| NPI | 1568795359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 53889) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 254774) |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2023-02-09 |