| NPI | 1316018146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 43708) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MA 43708) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2011-03-02 |