| NPI | 1043621246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 325587) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2017-01176) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2023-12-13 |