| NPI | 1861549214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 29084) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 153683) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2017-01-20 |