| NPI | 1023091360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 245199) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 159674) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2023-07-06 |