| NPI | 1154825248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 1019505) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 305076) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2025-08-26 |