| NPI | 1871938969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 074327) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 281021) |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2021-02-26 |