| NPI | 1962453647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 2091914) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 226973) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2026-04-29 |