| NPI | 1851898522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 88846) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: NY 1043889967) |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: CT 1992372403) | |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2024-08-29 |