| NPI | 1891887923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 257349) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 13159) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2023-02-08 |