| NPI | 1942295183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 163367) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS5417) |
| 207Q00000X Family Medicine (Licence: NH 13703) | |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2020-11-24 |