| NPI | 1659714582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 278707) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME DO3163) |
| 207Q00000X Family Medicine (Licence: NJ 25MB10470400) | |
| 207Q00000X Family Medicine (Licence: TX S3833) | |
| 207Q00000X Family Medicine (Licence: CO DR.0065537) | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2021-06-15 |