| NPI | 1417033440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY P132743) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2023006801) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2025-08-07 |