| NPI | 1336231539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 15867) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 19852) |
| 207Q00000X Family Medicine (Licence: ME 1303) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2024-06-10 |