| NPI | 1649340837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME137303) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 148746) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2020-01-29 |