| NPI | 1982653663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D63610) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 236069) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2022-10-05 |