| NPI | 1669835930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 173368) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 299835) |
| Enumeration Date | 2016-04-03 |
| Last Update Date | 2022-10-13 |