| NPI | 1861585580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 229085) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01057305A) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2017-02-28 |