| NPI | 1689875775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MA 58247) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NH 8784) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2014-10-02 |