| NPI | 1669505111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS17025) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 291018) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2023-04-11 |