| NPI | 1699939454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 79767) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 282170) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2024-11-19 |