| NPI | 1780181909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 307278) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 307278) |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2023-07-07 |