| NPI | 1578536991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2005-01292) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 209417) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2025-04-09 |