| NPI | 1962418475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2025-03847) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 193893) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2025-11-11 |