| NPI | 1952350589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 7509) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 195472) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2013-07-02 |