| NPI | 1639142391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 192934) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 39799) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2021-02-26 |