| NPI | 1184079154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 282234) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2019-00930) |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2020-07-13 |