| NPI | 1659543197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME121453) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 251833) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY 251833) | |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2024-01-04 |