| NPI | 1760421234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 158243) |
| Additional Taxonomies | 174400000X Specialist (Licence: NH 10205) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2017-03-28 |