| NPI | 1629538855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 307578) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 22309) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2026-02-05 |