| NPI | 1740442482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 272661) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116020796) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2019-11-23 |