| NPI | 1962030676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 326137) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61333179) |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2023-10-05 |