| NPI | 1902461411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 318443) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 318443) |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2023-07-18 |