| NPI | 1689024622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0092117) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 300755) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2025-06-06 |