| NPI | 1982044038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD181576) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 285201) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2022-07-21 |