| NPI | 1447606215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2026-00047) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 296284) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2026-04-06 |