| NPI | 1750488292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 229439) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 229439) |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2025-05-01 |