| NPI | 1538734660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS20656) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 319615) |
| 208D00000X General Practice (Licence: NY 319615) | |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2024-09-09 |