| NPI | 1942299292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 236618-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME168684) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2024-08-07 |