| NPI | 1942433289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301094236) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 266204) |
| Enumeration Date | 2009-09-03 |
| Last Update Date | 2020-10-15 |