| NPI | 1780617639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 296566) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 97-01772) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2019-02-13 |