| NPI | 1790072791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 291181) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME EC111067) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2019-12-04 |