| NPI | 1235525866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 324415) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 276535) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2024-08-28 |