| NPI | 1467529966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 66439) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 227262) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2026-04-23 |