| NPI | 1962465518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 291913) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS17044) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2024-09-20 |