| NPI | 1922014976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.50164) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 176697) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2025-04-01 |