| NPI | 1073830725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME136937) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 266408) |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2018-12-18 |