| NPI | 1689754582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 1666921) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS-6720) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2022-12-13 |