| NPI | 1861428849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 38308) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 016465) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2014-03-10 |