| NPI | 1598902082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME118431) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 251634) |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2026-07-14 |