| NPI | 1396907812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 14971) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 245763) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2016-03-22 |