| NPI | 1710513692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A198124) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 317407) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2025-04-07 |