| NPI | 1881216125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 324901) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 023367) |
| Enumeration Date | 2020-05-09 |
| Last Update Date | 2024-07-18 |