| NPI | 1487698833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA C44704) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI 5623) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2014-06-16 |