| NPI | 1679865885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12025) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 319913) |
| 207Q00000X Family Medicine (Licence: CA 20A13440) | |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2024-05-07 |