| NPI | 1699889261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 254924-01) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 226433) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2023-01-11 |