| NPI | 1104801026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 16952) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 76306) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2015-04-10 |