| NPI | 1255165247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 15409) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 250592) |
| Enumeration Date | 2024-08-30 |
| Last Update Date | 2024-10-04 |