| NPI | 1003030586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 259238) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 5472) |
| 207Q00000X Family Medicine (Licence: CT 049463) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2020-10-26 |