| NPI | 1790877827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 283974) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 24339) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2020-07-24 |