| NPI | 1033131883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME145947) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 210572) |
| 207Q00000X Family Medicine (Licence: MA 274001) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2025-01-03 |