| NPI | 1144841107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD29138) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 325017) |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2025-04-15 |