| NPI | 1841635646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 296058) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101260283) |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2022-09-06 |