| NPI | 1992115331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 275509) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 288047) |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2022-07-21 |