| NPI | 1922060631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 154560) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 10047) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2015-02-17 |