| NPI | 1285154419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 331761) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2018030876) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2024-09-25 |