| NPI | 1073133765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 83012) |
| Additional Taxonomies | 2080B0002X Pediatrics, Obesity Medicine (Licence: CT 83012) |
| 207Q00000X Family Medicine (Licence: NY 323590) | |
| 2083B0002X Preventive Medicine, Obesity Medicine (Licence: NY 323590) | |
| 2080B0002X Pediatrics, Obesity Medicine (Licence: NY 323590) | |
| 2083B0002X Preventive Medicine, Obesity Medicine (Licence: CT 83012) | |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2026-03-04 |