| NPI | 1033249800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 256959) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 76440) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2025-03-14 |