| NPI | 1851929749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2023-00525) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 322539) |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2023-11-29 |