| NPI | 1215499744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 22825) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 292982) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2022-08-02 |