| NPI | 1013941939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 159879) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 16383) |
| 207Q00000X Family Medicine (Licence: MA 277277) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2024-04-11 |