| NPI | 1750382966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 228788) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 228788) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2024-02-02 |