| NPI | 1609142611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD56884) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 280163) |
| Enumeration Date | 2012-03-25 |
| Last Update Date | 2020-09-29 |