| NPI | 1790165546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 277197) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116027984) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2023-08-22 |