| NPI | 1851327704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 12730) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 223332) |
| 207Q00000X Family Medicine (Licence: MD D0085707) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2018-09-14 |