| NPI | 1801992524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2021-00443) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 172739) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2021-10-27 |