| NPI | 1346229630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 19480) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 208532) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2019-11-21 |