| NPI | 1730593195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 270304) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT207443) |
| 207Q00000X Family Medicine (Licence: PA MD462240) | |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2023-04-24 |