| NPI | 1740383793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 19465) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 222926) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2019-07-18 |