| NPI | 1992324099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 1992324099) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY P102961) |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2023-03-14 |