| NPI | 1730476151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A134692) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 276094) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2024-07-02 |