| NPI | 1558700757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 301346) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME TD171016) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2025-07-11 |