| NPI | 1639137706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042.0016083) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 169902) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: NY 169902) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2022-08-12 |