| NPI | 1861451916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR md27954) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 215164) |
| Enumeration Date | 2006-03-18 |
| Last Update Date | 2020-11-06 |