| NPI | 1427045632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 11119) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 154397) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2012-08-23 |