| NPI | 1427545771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 93499) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL DO.2692) |
| 207Q00000X Family Medicine (Licence: NY 311150) | |
| Enumeration Date | 2018-04-21 |
| Last Update Date | 2026-07-14 |