| NPI | 1902959570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 035401) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 216586) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2015-06-09 |