| NPI | 1750332821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 165264) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME151589) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2025-04-17 |