| NPI | 1740661974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102206199) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 291541) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2022-05-27 |