| NPI | 1902125909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD19692) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 244361) |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2019-07-18 |