| NPI | 1790306926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA a199049) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 34228) |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2026-02-09 |