| NPI | 1699942441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 241996) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01080419A) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2024-03-13 |