| NPI | 1669583779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 88398) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 224291) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2025-09-03 |