| NPI | 1174609184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 166706-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 166706) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2023-07-03 |