| NPI | 1285608950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 281668) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 12819) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2021-03-02 |