| NPI | 1851680581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101274012) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 276189) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2022-05-05 |