| NPI | 1942426093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 1654) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 236395) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2024-06-14 |