| NPI | 1205360682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 304798) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 69982) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2026-06-22 |