| NPI | 1124905179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0116041733) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY P137752) |
| Enumeration Date | 2025-08-20 |
| Last Update Date | 2026-07-29 |