| NPI | 1871581942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD040786) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 205024) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2024-04-03 |