| NPI | 1033167697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-00114) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 175995) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2024-01-23 |