| NPI | 1841670536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 274541) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10300) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2024-01-12 |