| NPI | 1629362520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME131470) |
| Additional Taxonomies | 202K00000X (Licence: FL ME131470) |
| 207Q00000X Family Medicine (Licence: NJ 25MA09503700) | |
| 207Q00000X Family Medicine (Licence: NY 284759) | |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2021-04-16 |