| NPI | 1205137403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME110643) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA08303600) |
| 207Q00000X Family Medicine (Licence: NY 255281-1) | |
| 207Q00000X Family Medicine (Licence: WA MD60189759) | |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2014-05-22 |