| NPI | 1801856844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 57756) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI 7114) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2020-04-22 |