| NPI | 1295112761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 19635) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 15909) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2019-12-17 |