| NPI | 1710062245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60556970) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 242080) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2023-10-12 |