| NPI | 1265137236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 332023) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: NY 332023) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 332023) | |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2026-04-15 |