| NPI | 1629027990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 0642) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 166045) |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2026-01-02 |