| NPI | 1700207826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 291339) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO 3815) |
| Enumeration Date | 2013-12-16 |
| Last Update Date | 2024-08-07 |