| NPI | 1871589432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 282655) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 58409) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2016-03-06 |