| NPI | 1134392251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 16217) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 2125) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2018-07-02 |