| NPI | 1639499817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 293344) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD167007) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2023-12-04 |