| NPI | 1770286189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 344228) |
| Additional Taxonomies | 207QB0002X Family Medicine, Bariatric Medicine (Licence: NY 344228) |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2026-07-09 |