| NPI | 1972957769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 297621) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 63707) |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2024-07-17 |