| NPI | 1134143324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY 222211) |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: NY 222211) |
| 207Q00000X Family Medicine (Licence: NY 222211) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2026-04-07 |