| NPI | 1740600212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 294929) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2017-0234) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2021-10-01 |