| NPI | 1982993234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 258268) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101253834) |
| 207Q00000X Family Medicine (Licence: NY 274261) | |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2022-07-21 |