| NPI | 1376924373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 336914) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301108105) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2025-06-26 |