| NPI | 1437187655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 227933-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 227933) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2023-07-05 |