| NPI | 1679587356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 260995) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 225716) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2024-01-12 |