| NPI | 1801983390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 276303) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME123689) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2018-05-15 |