| NPI | 1578521894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301104183) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 232621) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2013-09-10 |