| NPI | 1578514683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL os10206) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 239398) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2026-04-15 |