| NPI | 1851774392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 326902) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A145882) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2024-11-04 |