| NPI | 1619065687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 238296) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI 11118) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2022-07-27 |