| NPI | 1235593104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 300849) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A158034) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2026-04-02 |