| NPI | 1003890641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 029717) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 76773) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2014-03-27 |