| NPI | 1760469142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS19282) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 208197) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2022-09-26 |