| NPI | 1720192586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME 2239) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 9404) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2013-01-04 |