| NPI | 1023013182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME154133) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 049720) |
| 207Q00000X Family Medicine (Licence: MA 227390) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2021-12-21 |