| NPI | 1497374748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 75815) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 324022) |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2023-08-24 |