| NPI | 1396058210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH LT-3688) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 254875) |
| 207Q00000X Family Medicine (Licence: PA MT198375) | |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2026-01-12 |